Provider Demographics
NPI:1801916531
Name:SADR, SHARON MARY (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARY
Last Name:SADR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 COLMAR QUARTER
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1247
Mailing Address - Country:US
Mailing Address - Phone:757-965-7497
Mailing Address - Fax:
Practice Address - Street 1:160 KINGSLEY LN STE 500
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4690
Practice Address - Country:US
Practice Address - Phone:757-889-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
014380N00Medicare PIN